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India's 5 most populous states adopt distinct Covid strategies

India's 5 most populous states adopt distinct Covid strategies
As the coronavirus disease (Covid-19) continues to spread, India’s most populated states have adopted both common, and distinct, strategies to deal with the pandemic.

Maharashtra, Uttar Pradesh, Bihar, Madhya Pradesh and West Bengal account for one-third of total 10,444 Covid-19 cases in India and about 40% of the country’s 1.21 billion population in 2011. Being densely populated, the probability of rapid spread of Covid-19 in these states was and remains higher than in less populated southern and Himalayan states. They are also more vulnerable because they house about 60% of 1.3 million migrant labourers in shelters across India.

While providing food to all, including about 20 million poor citizens in these states, was a challenge, the state governments adhered to health ministry’s guideline of testing and strong Covid-19 cluster management. They also launched apps to track hundreds of patients and put thousands of people in quarantine.

But they also opted for state specific models that helped in containing the spread. Maharashtra opted for aggressive testing (42,000 so far) and created the most number of containment zones in cities; Uttar Pradesh ensured that the virus is restricted to 41 of the 75 districts; Bihar focused more on isolating migrant workers and screening of all foreigners; Madhya Pradesh came across as lax initially before ramping up screening and testing efforts; and West Bengal termed its plan as containment with “humane face”.

Here is what each state did over the past month:

Maharashtra:

The state’s approach to Covid-19 infection and management has been distinct. It got most of the initial Covid-19 patients from foreign travelers, unlike other populated states, where the infection came primarily from secondary sources or attendees of Tablighi Jamaat congregation in Nizamuddin Delhi in mid-March.

After a rapid rise in the cases with an average of more than 150 positive cases and 12 deaths a day over last ten days , the state government shifted focus on the containment zones in Mumbai, adjacent areas, and other cities such as Pune that accounted for 90 % of the total positive patients and 91 % of total deaths.

The state has more than 400 containment zones, including 381 in Mumbai alone, highest for any city in India. The Brihanmumbai Municipal Corporation has divided these containment zones in three categories — red with more than 5-6 patients, yellow up to six patients and green with no cases.

“We have decided to concentrate on the most affected areas of Mumbai Metropolitan Region (MMR) and Pune by strictly implementing the lockdown. There are hotspots identified, in the containment zones, with the highest positive cases and they will be strictly monitored,” said state home minister Rajesh Tope.

As on Monday, 2334 people had tested positive and 149 had died due to Covid-19 in Maharashtra. Around 70% of these cases were reported in last ten days. MMR, which comprises of 9 municipal corporation and 20% of the state population has 1520 patients.

Uttar Pradesh:

The state focused on 41 districts, from where Covid-19 cases were reported and adopted a multi-pronged strategy of aggressive identification of hotspots, intensification of restrictions and creation of new health facilities combined with relief to people.

UP chief secretary RK Tiwari said that the UP model of “aggressive action to identify and act” has been appreciated by the Centre and others states have been asked to follow. When the Covid-19 pandemic first broke out, there was not even a single testing lab in the state. Now, the state has 10 labs and more are come up, he said.

The spurt in Covid-19 cases in Uttar Pradesh has been substantially attributed to the Tablighi Markaz in Delhi in last week of March. Additional chief secretary, Home, Avnish Awasthi said 50% of the cases in the state are linked to Tablighi Jamaat and the administration got them quarantined as soon as they were identified.

According to officials, 11 committees were set up to oversee the situation following lockdown announcement and suggest measures to provide relief to people. UP was the first state to announce financial relief of ₹1000 to half a million workers, daily wagers and vendors and is set to implement free distribution of food grains to nearly 30.54 million labourers.

UP so far has 550 Covid-19 cases with nearly 190 hotspots in 41 out of 75 districts. Five persons have died, 47 have recovered while about 11,855 tests have been carried out so far.

Madhya Pradesh:

With a full Cabinet not yet in place after the formation of the new government, and 72 health department officials tested as Covid-19 positive, containing the disease has proved to be a challenge for chief minister, Shivraj Singh Chouhan.

The data provided by the state government shows that Covid-19 has primarily been restricted to Indore and Bhopal, even though cases have been reported from 21 of the 52 districts in the state. Of the 562 Covid-19 positive cases, Indore with 311 patients accounted for 55.33% and Bhopal, with 134, 26.22% of total cases. Overall, Madhya Pradesh has 7.29% death rate while in Indore the death rate of 9.64%, higher than the national average of 3.4. Of the 41 deaths, 30 were from Indore.

Additional chief secretary, health, Mohd Suleman, appointed head of department a week back after the incumbent officer reported Covid-19 positive, said, “Our strategy has four components — Identification, Isolation, Test and Treatment (IITT).” He said any area visited by a foreigner or known for ILI (Influenza like illness) or respiratory problems, is declared a containment zone. Door to door survey is done to list people with different categories of diseases and they are marked as high or low risk. “The test is then either done of high risk persons eat home or at a testing centre,” he said, adding that fourth component is treating people tested positive.

The state has 282 containment areas with about half of them in Indore. The affected 21 districts have curfew restrictions while borders of Bhopal, Indore and Ujjain have been sealed to prohibit entry or exit of any person. Indore, the worst affected city, has been divided into five sectors, with a senior officer in-charge of each sector.

Bihar:

With 65 cases in the state of 100 million people, the Bihar government has now opened its outpatient facilities for all, the first big state to do so, in an indication of the state’s confidence that the situation was under control. Experts however believe the state may not have tested aggressively enough. Less than 8000 tests have been carried out so far.

State chief secretary Deepak Kumar, however, said the state tested all international passengers who came between March 18 and 23 and all symptomatic cases, who came between March 15 and 17, were also tested. It identified around 3,556 international travelers between March 15 and 23 and samples of 2,254 people, who were within the 14-day incubation period, were taken for tests.

Bihar also followed the model of containment zones, where people have not been allowed to move out of their homes and essential supplies delivered to them at their doorstep, said Sanjay Kumar, Bihar’s principal secretary, health. For instance,

Panjwar village of Siwan district, where 23 of the 29 cases in the district were reported, was declared ‘red zone’ and complete barricading of the village was done at 200 metres, 500 metres, 1km, 2km and 3km.

Places visited by Tablighi Jamaat attendees were sanitised and mosques, where they were staying were sealed.

West Bengal:

The state, with 95 Covid positive cases and seven deaths, has been warned by the home ministry for not enforcing lockdown norms strictly. Chief minister Mamata Banerjee, however, had said they had opted for “lockdown with humane face” and imposed complete clampdown in Covid-19 hotspots.

“Some areas where people have tested positive for Covid-19, and there is a threat of the disease spreading, have been totally sealed,” said a health department official, on the condition of anonymity.

The state has formed an advisory body roping in international experts (such as Nobel laureate economist Abhijit Banerjee) and has also formed three task forces and a few other committees to guide the state in tackle coronavirus.

“We are prepared. The state now has seven testing laboratories, 64 hospitals are earmarked for Covid-19 patients and there are more than 580 quarantine centres,” said a second official of the health department.

The state government has been criticized for opaque information system on Covid with the health bulletins providing information only on active cases. Officials, however, explained that the information was being provided only after vetting by experts, who had termed most deaths because of co-morbidity.

(With inputs from state bureaus)

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